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U.S. Healthcare Crisis Turnaround?

U.S. A.

Drs. & Hospitals Employers

$1.0 Trillion / Year

$$$ ERISA $$$

50% Savings

The Only Company with Compliant Solutions for All of You

Rx-1  $$$$$$$$$ERISA"Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance
$$$$$$$$$$  Rx-2
US Supreme Court Visits

at 11:57:03 AM on Friday, November 21, 2003

New Federal Health Claims & Appeals Laws & Regulations

for 193 Million Americans

Effective 09-23-2010

©2010, Jin Zhou,

Photo of President Gerald R. Ford signing Employee Retirement Income Security Act of 1974

President Obama Signing Health Bill on 03/23/2010

President Gerald R. Ford Signing ERISA on 09/02/1974

New Webinars, Seminars & Certification Classes Announced for New Federal Health Claim Appeals Regulations on July 22, 2010 from HHS, DOL & IRS, Effective On Sept. 23, 2010 for 193 Million Americans

DOL Seal - Link to DOL Home Page



(Links to DOL) ©2010, Jin Zhou,

Patient Protection and Affordable Care Act

Statutory Laws [PDF] [PDF]



Employee Retirement Income Security Act — ERISA


Webinars, Seminars & Certification Classes for New Federal Health Claim Appeals Regulations - Free Webinars - New Federal Claims & Appeals Regulations, Effective Sept. 23, 2010, for 193 Million Americans Seminars - 2010 Two-day Basic ERISA Appeal Seminars - Denials and Overpayment Appeals - 2010 PPACA & ERISA Claim Specialist Certification Programs in Chicago, Illinois  Create An Appeal Department for Your Hospital or Practice (In-house, onsite ERISA Claim Specialist Certification Programs)


Copyright Notice

Jin Zhou, the author and publisher of, owns all copyright, intellectual property, and other interests related to's website, publications, consulting, and seminars, including but not limited to its ERISA Appeals CD Book & Systems,'s News Letters, "Zhou's Model of Prudent Health Care", "U.S. Healthcare Crisis Turnaround Rx", and entire website content, except for those contents or art works quoted or cited from governmental and judicial publications or hyperlinked to external websites or resources.





Except for "PRINTING FOR PERSONAL USE ONLY" as defined hereinbelow, no content from's website or from its publications, including but not limited to our Appeal Letters or Forms from our eBook or CD-Book Appeal Systems,  may be copied, downloaded, stored in a retrieval system, re-engineered, modified, used to create derivative works including but not limited to Powerpoint presentation, seminar handouts, news letters, modified Appeal Letters or Forms  or reproduced or transmitted in any form or by any means, electronic, mechanical, photographic, photocopying, recording, scanning, or otherwise, without prior written permission from Jin Zhou of No content from's website or from its publications may be posted or used on other websites, intranet sites, bulletin boards, news services, message groups, or in any other manner, in whole or in part, without prior written permission from Jin Zhou of It is unlawful for anyone to participate in the transfer or sale of, create derivative works from, or in any way exploit any content of's website or its publications without prior written permission from Jin Zhou of





You may copy or store a few pages of this website on your personal PC or workstation for individual use or reference.


You may print one hardcopy of a few pages of content from this website or from our publications, such as our eBook, CD-Book, for your personal or individual use, which may include sending the printed pages to a co-worker or client who has requested information from you (but you must warn him/her in writing that copyright law prohibits him/her from redistributing to anyone else).


You may also store our entire eBook or CD-Book on your personal PC on the basis of one copy of CD-Book per PC/CPU only, instead of on a network system.


Other than the above, you may not print pages and/or distribute content from's website or publications, online or off-line, digital or paper,  without  prior written permission from Jin Zhou of Institutional copies or licensing are required for network storage or institutional distribution of our CD-Book or any publications.





For $250 per article, you can purchase a license that permits you to reprint an article from the website on the condition or in terms of "As Is" in your electronic or print newsletter and/or post it on your password-protected Web site for your employees or clients. Please send an email to Copyright InfoDesk: identifying what article you wish to license and for what purpose.



SEMINARS:'s seminars and its associated publications, Power presentations, handouts, course materials, and CD-Book Appeal Systems, are copyrighted as disclosed and defined in this Copyright Notice. Tape or any forms of digital recording are not allowed or permitted. Seminar materials are subject to the copyright restrictions as defined herein with respect to onsite presentations and on-line or off-line publications, digital or paper publications.





Requests for permission other than a request to license an website article should be addressed to Copyright InfoDesk: Include the following information: (a) the content you wish to use; and (b) a description of the planned use, including quantity and the intended recipient(s). Please allow several days for a reply. Permission is granted on case by case basis.






The unauthorized use, submission or distribution of copyrighted or other proprietary content is illegal and could subject the violator to personal liability for damages in a civil suit resulting from any infringement of copyrights or other proprietary rights, or from any other harm arising from the unauthorized use, submission or distribution.


Unauthorized attempts to upload information or change information on this service are strictly prohibited and may be punishable under the Computer Fraud and Abuse Act of 1986 and The National Information Infrastructure Protection Act of 1996.







For security purposes and to ensure that this service remains available to all users, our Web site also employs software programs to monitor network traffic to identify unauthorized attempts to upload or change information, or otherwise cause damage. You are hereby notified that use of this site constitutes consent to such monitoring and the above captioned "Copyright Notice" and the following  "Legal Disclaimers".

If you visit our site, we collect and store the following information only: the name of the domain from which you accessed the Internet (e.g.,; the IP address from which you accessed this site; the date and time you accessed the site; and the pages you visited.

Unauthorized attempts to upload information or change information on this service are strictly prohibited and may be punishable under the Computer Fraud and Abuse Act of 1986 and The National Information Infrastructure Protection Act of 1996. Unauthorized modification of any information stored on this system may result in criminal prosecution.


The author and publisher of is not responsible for the creation or maintenance of web sites linked to this site, and does not vouch for the accuracy, completeness, or currency of any of the materials included on them.



Legal Disclaimer

    The publication or information on this Website is designed to provide accurate and authoritative information in regard to the subject matter covered. It is presented and published with the understanding that the author and publisher are not engaged in rendering legal, accounting or other professional service or advice. If legal advice or other expert assistance is required, the services of a competent professional person should be sought.


    We're not employees of, or in affiliation with any governmental or regulatory agencies. is not a law firm. We do not practice law. If legal action or advice is required to successfully resolve a claim or a claim/business decision, we will refer out our client to an outside legal counsel chosen by our client.


    We do not teach, advise or participate in coding & billing of your health care claims and practice.  We advocate  appeals of your already denied claims through compliance and compliant claim processing for savings in accordance with ERISA claim regulations and applicable federal and state laws.


    Although often works in conjunction with, but completely independent from, different law firms or seminar sponsors whose practice is focused on the representation of or advising clients in health care ERISA claims dispute or compliance, those  law firms or companies advertising on are not affiliated with or employed by or with disclaims any and all responsibility or liability for the accuracy, content, completeness, legality, reliability, or operability or availability of information or material displayed or advertised on the disclaims any responsibility for any harm resulting from downloading or accessing any information or material on the Internet linked to or through the


    Except for otherwise specifically stated, our educational and training for certification programs are not affiliated with any governmental or educational institute for the purpose of "recognized accreditation or certification for compliance programs or compliance officers" or degrees. Our certifications are only for personal attendance in private studying subject materials specified in each individual programs for advancing educational knowledge with respect to applicable business and  compliance.


OIG: Special Advisory Bulletin: Practices of Business Consultants [PDF] []
The Office of Inspector General (OIG), Department of Health and Human Services
, June, 2001



The Root of U. S. Healthcare Crisis

Jin Zhou,

The Hearing at Senate Committee on Finance on 3-3-04, [View Video or Transcript (PDF) (]  revealed the mechanism, nature and extent of ERISA failure and nonenforcement as the reasons for "Growth in Bogus Health Insurance Plans Targeting Desperate Small Business Owners", as being concluded as "No the results are not good. It’s a tragedy." by Ann Combs, assistant secretary of DOL. The mechanism, nature and extent of ERISA failure and nonenforcement as presented at the Hearing are universally true and applicable to all health care claim denials and delays in managed care environment from all employer sponsored health plans as the root of U. S. healthcare crisis.


This is a 911 call on "healthcare 9/11 disaster"!



ERISA & Claim Denials

Aetna Video Shows ERISA Patients Mistreated


"According to the video, when faced with claims for identical medical problems, Aetna separates the claims where no damages are available - those subject to the federal Employee Retirement Income Security Act, or ERISA - from non-ERISA claims, where consumers can sue.1 2"


ERISA & Health Claim
What Is ERISA and How Does It Affect Patient Rights?


"ERISA was enacted in 1974 to protect the pension and welfare benefits that employers provide their workers. It currently covers about 2.5 million health plans and 125 million workers, retirees, and dependents."


Department of Labor

"A group health plan is an employee welfare benefit plan established or maintained by an employer or by an employee organization (such as a union), or both, that provides medical care for participants or their dependents directly or through insurance, reimbursement, or otherwise.

Most private sector health plans are covered by the

 Employee Retirement Income Security Act (ERISA). Among other things, ERISA provides protections for participants and beneficiaries in employee benefit plans (participant rights), including providing access to plan information. Also, those individuals who manage plans (and other fiduciaries) must meet certain standards of conduct under the fiduciary responsibilities specified in the law."



$10,600 ERISA Claim

Recent Federal Court Ruling in a Case with $10,600 medical claim, insurance Co. refused to pay, provider made numerous demand for payment in almost one year, but no appeals filed, the court dismissed the lawsuit because provider failed to exhaust administrative remedy, as required under ERISA, by filing ERISAclaim appeals.  This situation is so popular in health-care community.



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